Method and apparatus for self-administering pre-hospital phase treatment of coronary prone individuals in the early minutes or hours after the onset of heart attack symptoms

ABSTRACT

Method for self-administering prehospital phase treatment of coronary prone individuals during the early minutes or hours after the onset of heart attack symptoms and apparatus for use therein. The apparatus comprises the combination of a portable battery-operated device having circuitry operable when operatively connected with an individual to produce audible signals capable of telephone transmission in the form of a beep corresponding with each heart beat of the individual and rate range signal in the form of different colored lights each corresponding to a predetermined rate range and a plurality of different automatic injectors each color-coded to the signal lights and containing different medicaments which are effective within the corresponding rate range and may be adversely effective outside the corresponding rate range. The method includes performing the following steps within the early minutes or hours after the onset of heart attack symptoms: (1) obtaining access to the apparatus, (2) establishing an operative connection between the device and the individual, (3) producing the signals, (4) utilizing the signals to determine the injector containing the medicament effective under the existing heart beat conditions, (5) identifying the applicable injector and (6) selfadministering the injector to inject the medicament therefrom into the individual.

United States Patent 1 Sarnoff Mar. 11, 1975 METHOD AND APPARATUS FOR SELF-ADMINISTERING PRE-HOSPITAL PHASE TREATMENTOF CORONARY PRONE INDlVlDUALS IN THE EARLY MINUTES OR HOURS AFTER THE ONSET OF HEART ATTACK SYMPTOMS [75] Inventor: Stanley J. Sarnoff, Bethesda, Md.

[73] Assignee'. Survival Technology, lnc., Bethesda,

22 Filed: Oct. 12, 1972 [21] Appl. No.: 296,841

Related U.S. Application Data [63] Continuation of Ser. No. 55,647, July 17, 1970,

abandoned.

[52] U.S. Cl. 128/2.05 T, l28/2.l A, 128/213 [51] Int. Cl A6lb 5/02 [58] Field of Search 128/205 A, 2.05 P, 2.05 R, 128/205 S, 2.05 T, 2.06 A, 2.06 F, 2.06 R,

OTHER PU BLlCATlONS Molyneux et 211., British Journal of Anaesthesia," Vol.27 1955,pp.26l263.

Cushman ABSTRACT Methodfor self-administering prehospital phase treatment of coronary prone individuals during the early minutes or hours after the onset of heart attack symptoms and apparatus for use therein. The apparatus comprises the combination of a portable battery operated device having circuitry operable when operatively connected with an individual to produce audible signals capable of telephone transmission in the form of a beep corresponding with each heart beat of the individual and rate range signal in the form of different colored lights each corresponding to a predetermined rate range and a plurality of different automatic injectors each color-coded to the signal lights and containing different medicaments which are effective within the corresponding rate range and may be adversely effective outside the corresponding rate range. The method includes performing the following steps within the early minutes or hours after the onset of heart attack symptoms: (1) obtaining access to the apparatus, (2) establishing an operative connection be tween the device and the individual, (3) producing the signals, (4) utilizing the signals to determine the injector containing the medicament effective under the existing heart beat conditions, (5) identifying the applicable injector and (6) self-administering the injector to inject the medicament therefrom into the individual.

13 Claims, 8 Drawing Figures PMENTED 1 i975 3870035 [U 1 BF 3 I ATTORNEY PATENIEBHAR I I I975 SHLET 2 0F 3 Blue Yellow m Green INVENTOR.

Sfan/ey J Sarnoff HY JMm/M% METHOD AND APPARATUS FOR SELF-ADMINISTERING PRE-HOSPITAL PHASE TREATMENT OF CORONARY PRONE INDIVIDUALS IN THE EARLY MINUTES OR HOURS AFTER THE ONSET OF HEART ATTACK SYMPTOMS This is a continuation of application Ser. No. 55,647, filedJuly 17, 1970, now abandoned.

BACKGROUND AND SUMMARY OF THE INVENTION A majority of people who sustain what is commonly called a heart attack (acute myocardial infarction) die prior to arrival in the hospital, i.e., in the early minutes or hours after the onset of the attack. It is now known that ventricular fibrillation, a chaotic, uncoordinated, non-pumping contraction of the hearts ventricular muscle fibers figures prominently in producing sudden death in the prehospital phase. The mechanism which in turn precipitates ventricular fibrillation, either directly or indirectly, is generally accepted to be a ventricular ectopic beat (also called a premature ventricu lar contraction), an electrical impulse which arises in an abnormal or ectopic place. Such an ectopic impulse is therefore a trigger for the fatal event of ventricular fibrillation in sudden death prior to arrival in the hospital.

From the above, it has become apparent that a key consideration in preventing a large number of coronary deaths before arrival in the hospital is the suppression of ectopic beats in the prehospital phase. Fortunately, drugs are available which can importantly influence the incidence of ectopic beats and frequently suppress them entirely. The two most widely used drugs at present are lidocaine and atropine. The latter drug is also frequently helpful in correcting the varying degrees of heart block and the low blood pressure that sometimes accompanies an acute coronary heart attack. Such drugs are in frequent use in hospitals and Coronary Care Units for the purposes above described.

Several further considerations are, however, relevant to the self-injection of such drugs in the presence of an acute heart attack in the prehospital phase. While lidocaine is generally useful in the suppression of ectopic beats, it is not advised when the heart rate is below a limit of 60 to 65 beats per minute because it has been observed that when the heart rate is below this level (bradycardia), the use of lidocaine either may actually increase ectopic activity or slow heart rate further if complete heart block is present. Atropine, on the other hand, is most useful at bradycardia rates below 60 to 65 per minute since it will elevate the heart rate, a maneuver observed to diminish or abolish the incidence of ectopic beats when bradycardia is initially present. The use of atropine when the heart rate is already quite elevated may be unwise.

Color coded automatic injectors (see Sarnoff US. Pat. No. 2,832,339) have been designed for the selfadministration of atropine and lidocaine so that a coronary prone (acute heart attack prone) individual can self-inject himself with the appropriate drug should he suddenly experience severe and persistent chest pain. Some means for freeing himself from doing anything but the very simplest determination in order to select the proper drug under the very highly disconcerting circumstances of his attack is therefore required.

The invention which is the subject of this application will provide such means. Said invention will also pro- 'vide ready means, without the need for auxiliary attachments, of conveying information concerning the rate and regularity (or irregularity due to ectopic beats) of his heart beat to the patients physician or rescue center by means of an'extendable speaker which is capable of being immediately and simply affixed to the telephone.

In view of the foregoing it is an object of this invention to provide apparatus for diagnosing certain aspects ofa hearts condition in a patient by detecting the heart beat rate and regularity and having means for indicating the need and type of medication required based on the detected rate.

It is a further object of this invention to provide the apparatus of the above object with means for providing an audible signal responsive to the detected heart beat.

It is another object to provide the diagnostic means with a plurality of frequency band units which are responsive selectively to the detected heart beat and indicator means responsive to said frequency band.

It is still a further object to provide the indicator means with color coded lights responsive to the frequency band units.

It is another object of this invention to provide medicaments color coded to cooperate with the color coded lights to indicate which medication is to be used.

DESCRIPTION OF THE DRAWINGS The above and other objects and advantages will become more apparent when taken in conjunction with the following description and drawings. in which:

FIG. I is a front plan view of the entire unit.

FIG. 2 is a front plan view similar to FIG. 1 with the front cover removed,

FIG. 3 is a pictorial view illustrating one way in which the apparatus may be used.

FIG. 4 is a bottom elevational view of the unit,

FIG. 5 is a elevational view of the unit, taken along line 5-5 of FIG. 1,

FIG. 6 is a sectional view taken along line 66 of FIG. 1 with the loudspeaker removed showing the reel construction and mounting in the casing,

FIG. 7 is a bottom elevational view illustrating a modification wherein the medicaments are positioned immediately adjacent their respective light indicators and,

FIG. 8 is a diagram illustrating a typical circuit for the apparatus of this invention.

DESCRIPTION OF THE INVENTION In the apparatus of this invention, the heart beat is detected from the patients finger which is positioned in a sensing unit. Referring to the embodiment of FIG. 8, lamp 1 illuminates the surface of the skin of the patients finger which has been placed in the sensing unit. The quantity of light reflected from the skin varies in accordance with the quantity of blood present which in turn varies during each heart beat. This variation modulates a photosensitive resistor 2 which together with resistor 3 forms a voltage divider. There are numerous additional ways of sensing heart beat at the finger. The one described herein is used solely to provide an operative disclosure. Another finger unit for sensing heart beat is described in US. Pat. No. 3,450,133 to Harris, Jr. It should also be noted that the heart beat could be sensed at some body part other than the finger by conventional means and still provide the desired signal.

The AC component of the modulated voltage divider is transmitted through capacitor 4 to linear amplifier 5. The amplified output from 5 operates a Schmitt trigger 6 which gives a square wavefront whenever the preselected trigger level is exceeded.

The output from Schmitt trigger 6 is differentiated by capacitor 7 and resistor 8 to trigger the one-shot multivibrator 9. The output of the one-shot multivibrator 9 thus releases a train ofimpulses of equal amplitude and duration whose frequency varies as the heart beat rate. This signal is integrated in the network comprising resistor 10, capacitor 11 and resistor 12 to provide a voltage at point Y which is a function of the heart beat rate.

In order to accurately measure the heart beat rate, the voltage at point Y is compared to the voltage across a calibrated potentiometer 13 by means of a null meter 14. Thus, when the meter 14 has been nulled by varying the potentiometer 13, the calibration of the potentiometer is such that it reads in heart beats per minute. The meter 14 is also employed to check the condition of the battery power supply by means of gang switch SWlA and SWlB in conjunction with the potentiometer 13. As shown in FIG. 8, the gang SW1 is the normal operating position wherein the potentiometer 13 and null meter 14 are in series with the remainder of the circuitry across the battery power source. When it is desired to check the battery, the switch SW1 is moved to the position shown in dotted lines whereby the potentiometer and null meter are placed directly across the battery. If the battery is in operating condition, the needle will move into the shaded area as in FIG. I.

In order to provide a beep or other similar sound corresponding to the heart beat, one-shot multivibrator 9 is connected to pulsed audio oscillator 15 which is in turn connected to loud speaker 16 so that every signal from the one-shot multivibrator which represents a single heart beat will be made audible by the oscillator and loudspeaker.

An additional determination of heart beat rate within prescribed ranges of 25-65, 65-110 and over 1 10 pulses per minute (ppm) is made by means of the level detectors 1 7 and 18 and associated circuitry. More particularly the voltage appearing at point Y which is a function of the heart beat rate is connected to level detectors l7 and- 18, AND gate 19 and gang switch SW1. At the same time, the one-shot multivibrator 9 is emitting at X a train of pulses whose frequency corresponds to the heart beat rate. This signal is continuously transmitted to AND gate 21, AND gate 20, and AND gate 19.

The operation of the pulse range band circuitry is as follows. When the voltage at point Y is such that a pulse rate of over 110 is indicated, level detector 18 will be actuated to send out a signal inhibiting AND gate 20 and AND gate 19. At the same time, a pulse signal from point X is received by all three AND gates 19, 20, and 21; however, AND gates 19 and 20 have been inhibited, thus only AND gate 21 is actuated. The AND gate 21 will energize driver 22 and in turn yellow lamp 23 will be energized indicating that the heart beat rate is over 110 ppm. 7

When the heart beat rate is between 65 and 1 10 ppm only level detector 17 will be actuated. This level detector will send out a signal inhibiting AND gate 19, thus only AND gate 20 will be operative. AND gate 20 upon receiving a signal from point X and level detector 17 will actuate driver 26 and thence blue lamp 27 to indicate that the heart beat rate is between 65 and l 10 ppm. Lastly, when the heartbeat rate is between and 65 ppm. neither level detector will be energized,

' thus the only AND gate to be actuated upon receiving signal from point X will be 19 which in turn actuates driver 24 and green lamp 25 to indicate that the heart beat rate is between 25 and 65 ppm.

As a matter of precaution to avoid the possibility of leaving the main switch on and perhaps depleting the battery power supply, the main switch has been incorporated in the sensing unit. Thus when the finger is placed in the sensing unit, the main switch is operated to place the circuit in operative condition.

Referring to FIG. 5, it will be noted that the sensing unit 50 comprises a U-shaped base 51 pivotally mounting an upper U-shaped member 52 by means of pin 53. A microswitch 54 is positioned on the base 51 in the end opposite to that which receives the finger so that its plunger 56 will be engaged by the upper U-shaped member 52. This microswitch 54 is noted on FIG. 8 as the main switch. Upon introduction of the finger between the base 51 and upper U-shaped member 52, the end portion of said member will be pivoted downwardly as indicated by the arrow to close the main circuit for the unit.

As illustrated in FIGS. 1 to 6, the device of this invention comprises an outer generally rectangular plastic casing 48 with the sensing unit 50 removably secured to the top end thereof by Velcro fastening means 55. The front face of the casing 48 is bisected to form two panels 57 and 58. The panel 57 provides access to the four 1.25 volt rechargeable batteries 60 employed as the power source. The panel 58 is provided with a circular opening 62 through which extends a portion of the loudspeaker wire reel 64.

As best illustrated in FIG. 6, the reel 64 comprises central cylindrical body 68 having a circular bottom 70 with an outwardly extending peripheral flange 72 and a central downwardly facing circular protuberance 74. The top .of the body 68 is provided with an annular head 76 having an inner diameter coextensive with the inner diameter of the body. The head 76 includes an offset providing an outwardly extending flange 78 and an upwardly projecting reel top 80. The reel 64 is rotatably carried in the casing 48 in the following manner. Casing back 81 is provided with a circular depression sized to receive the reel protuberance 74 so that the reel 64 will be properly centered in the casing bottom. The circular opening 62 in panel 58 is sized to accommodate the reel top while the upper face of the flange 78 will be in loose contact with the lower face of the panel 58. Thus the reel 64 is rotatably held in position in the casing 48. It should be noted that the reel 64 is provided with a vertical slot 82 extending from the reel top and down the major portion of the spool body 68.

Referring to FIGS. 1 and 2, a loudspeaker is carried within the reel body 68 and the wire 92 connected to the loudspeaker fits down through slot 82. The wire 92 is wound on reel body 68 and has a loop 94 extend ing through an aperture in the casing side wall. The other end of the wire 92 is connected to the circuitry of FIG. 8 just past one-shot multivibrator 9 so as to re ceive signals therefrom indicative of heartbeat. A ring 96 is held in the loop 94 so that when it is desired to unreel the wire 92 from the reel, the ring 96 is pulled outwardly to withdraw the wire and thus form a large loop. After this, the loudspeaker 90 is removed from the reel body and the loop decreased by pulling it through the aperture in the casing side wall until the ring 96 prevents further movement by bearing on the casing side wall.

In order to wind the wire 92 on the reel body 68, the loudspeaker is placed in the reel with the wire fitting down into slot 82. Then the ring 96 is pulled to again provide a large loop drawing the wire taut. After this, a pin is placed in pin hole 98 in the reel top and the reel rotated until the loop is diminished to the point where the ring engages the casing side wall and prevents further decrease in loop size.

The unit is also provided with ajack 1.00 in the casing side wall. This jack is connected into the circuitry of FIG. 8 at point Y so that it receives a variable voltage indicative of heart beat rate. This jack provides connections for the conventional type of averaging meter which measures pulse rate and may also be employed to furnish signals to electronic equipment which reproduces the signals in useable visual form.

A disc 110 graduated in ppm is rotatably mounted in the casing 48 in operative engagement with the calibrated potentiometer l3 ofFlG. 8. Rotation of the disc 110 until the null meter 14 is nulled by the alignment of needle 112 with the zero on the scale 114 will provide the heart beat rate by referring to the calibrations on disc 110 as viewed through opening 115 and as aligned with index mark 116. The disc 110 is color coded in frequency bands to correspond with the lights of the unit.

The index 114 is provided with a shaded area for use in a battery check as follows. Depression of switch button 118 causes gang switch SWlA-SWIB to assume the dotted line position shown in FIG. 8, thus closing the battery test circuit. If the needle 112 moves to the shaded portion 117 as illustrated in FIG. 1 then the battery is in operating condition.

The loudspeaker 90 is provided with a projecting pin 91 sized to fit into the holes in a perforated plate of the mouth-piece of a telephone. Along these lines, attention is directed to FIG. 3 illustrating a basic use of the heart beat detector unit. As shown, the loudspeaker 90 has been removed from the spool 64 and the wire 92 unreeled as previously outlined. The patients finger is positioned in sensing unit 50 by pivoting of the upper member 52 and thereby closing the main switch 54. The heart beat is sensed by the unit 50 and ultimately reproduced in audible form at loudspeaker 90 which has been mounted on the telephone mouthpiece by means of loudspeaker pin 91 fitting into a hole in the telephone mouthpiece plate 120.

At the same time that the signal is being produced at the loudspeaker 90, it is also being received by the frequency band circuits for determination of what frequency band that the heart beat rate comes within. Referring to FIG. 4, the three lights tied into the frequency bands are visible.

As a matter of convenience, the side wall opposite that carrying the jack I00 is provided with a lengthwise projection 130 to act as a reel for the wire 132 of sensing unit 50.

It is also contemplated that the unit will be furnished with medicaments color coded to correspond to the frequency bands of the unit. In this connection, reference is made to Flg. 7 illustrating same. The back 81 of the casing is provided with a three compartmented receptacle secured directly beneath the color coded lights 25, 27 and 23. Each compartment is provided with a medicament in a container color coded to correspond to its compartment which is in turn color coded to correspond to the lights 25, 27 and 23. Thus it is apparent that a rapid decision and medication is made possible by this combination unit.

I claim:

1. A method for effecting pre-hospital phase selfadministered treatment of a coronary prone individual at a time during the early minute or hours after the onset of heart attack symptoms and for enabling qualified personnel to participate by telephone in such treatment, which individual has previously been provided with ready access to (l a plurality of separate injectors suitable for self-administration under the disconcerting circumstances present during the aforesaid time, each containing a liquid dosage of a different medicament injectable into the tissue of the individual effecting the self-administration of the injector, each of which medicaments (a) when so injected is generally effective to reduce the incidence of adverse cardiac conditions, such as ectopic beats, when the existing heart beat condition is within a different predetermined portion of the total range of heart beat conditions which may exist during an attack, and (b) may be inadvisable or unwise to inject when such heart beat conditions are outside the predetermined portion of the total range in which the medicament is effective as aforesaid, and (2) a diagnosing device having sensing means operable to be simply and conveniently disposed in operative relation to an individual for sensing a phenomena indicative of the individuals heart beat conditions and battery oper atcd signal producing means operable when said sensing means is disposed in said operative relation to produce signals indicative of the sensed heart beat conditions of the individual, including a signal corresponding with each successive heart beat of the individual capable of being transmitted by telephone, said method comprising the steps of:

l. obtaining access to the aforesaid accessible device and injectors by said individual;

2. manually establishing by said individual an operative relation between said individual and the sens ing means of-the device to which access has been obtained as aforesaid;

3. sensing through the operation of the sensing means while in said operative relation a phenomena indicative of the existing heart beat conditions of the individual;

4. producing through the operation of said battery operated signal producing means signals indicative of the sensed heart beat conditions of said individual including a signal corresponding with each successive heart beat of said individual capable of being transmitted by telephone; I

5. utilizing at least some of the signals produced as aforesaid as a basis for determining an indicated injector containing the medicament which is effective as aforesaid;

6. visually identifying by said individual the indicated injector containing the effective medicament as aforesaid, and

7. self-administering by said individual the identified injector containing the effective medicament and injecting said effective medicament into the tissue of said individual so that said injected medicament will reduce the incidence of adverse cardiac conditions, such as ectopic beats, in said individual prior to the arrival of said individual at a hospital.

2. A method as defined in claim 1 wherein the produced signals include at least one of a plurality of different visual signals each of which is produced by the signal means when a different predetermined portion of the total range of heart beat conditions corresponding respectively to the aforesaid different rate portions associated with each medicament is sensed by said sensing means.

3. A method as defined in claim 2 wherein the visual signals produced are colored lights, corresponding injectors having color indicia corresponding in color respectively to said colored lights, and wherein said individual experiencing heart attack symptoms utilizes the colored light produced by said signal means as a basis for determining the indicated effective medicament and identifies the injector containing the indicated effective medicament by identifying the injector having color indicia corresponding to the color of the produced colored light.

4. A method as defined in claim, 1 wherein the medicaments contained within the injectors include atropine and lidocaine.

5. A method as defined in claim 1 wherein the injection of the medicament is accomplished automatically by the injector during said self-administering step.

6. A method as defined in claim 5 wherein the medicaments contained within the injectors include atropine and lidocaine, the portion of the total range of the heart beat conditions wherein atropine is effective as aforesaid being a heart beat rate below 60 to 65 beats per minute, above which atropine may be inadvisable to inject as aforesaid and wherein each signal corresponding to each successive heart beat is a distinct audible signal, such as a beep.

7. A method for effecting pre-hospital phase selfadministered treatment of a coronary prone individual at a time during the early minutes or hours after the onset of heart attack symptoms and for enabling qualified personnel to participate by telephone in such treatment, which individual has been previously provided with ready access to (l) at least one injector suitable for self-administration under the disconcerting circumstances present during the aforesaid time containing a liquid dosage ofa medicament injectable into the tissue of the individual effecting the self-administration of the injector, which medicament (a) when so injected is generally effective to reduce the incidence of adverse cardiac conditions, such as ectopic beats, when the existing heart beat condition is within a predetermined portion of the total range of heart beat conditions which may exist during an attack, and (b) may be inadvisable or unwise to inject when such heart beat conditions are outside the predetermined portion of the total range in which the medicament is effective as aforesaid, and (2) a diagnosing device having sensing means operable to be simply and conveniently disposed in operative relation to an individual for sensing a phenomena indicative of the individuals heart beat condition and battery operated signal producing means operable, when said sensing means is disposed in said operative relation to produce 'signals indicative of the sensed heart beat conditions of the individual, including a signal corresponding with each successive heart beat of the individual capable of being transmitted by telephone, said method comprising the steps of:

1. obtaining access to the aforesaid accessible device and injector by said individual;

2. manually establishing by said individual an operative relation between said individual and the sensing means; i

3. sensing through the operation of the sensing means while in said operative'relation a phenomena indicative of the existing heart beat conditions of the individual;

4. producing through the operation of said battery operated signal producing means signals indicative of the existing heart beat conditions of said individual including a signal corresponding with each successive heart beat of said individual capable of being transmitted by telephone;

5. utilizing at least some of the signals produced as aforesaid as a basis for determining that the injector obtained by said individual contains medicament which is effective as aforesaid;

6. visually identifying by said individual the injector containing the effective medicament, and

7. self-administering by said individual the identified injector containing the effective medicament and injecting said effective medicament into the tissue of said individual so that said injected medicament will reduce the the incidence of adverse cardiac conditions, such as ectopic beats, in said individual prior to the arrival of said individual at a hospital.

8. Apparatus for effecting pre-hospital phase selfadministered treatment of a coronary prone individual at a time during the early minutes or hours after the onset of heart attack symptoms and for enabling qualified personnel to participate by telephone in such treatment comprising the combination of:

a plurality of separate injectors suitable for selfadministration under the disconcerting circumstances present during the aforesaid time, each containing a liquid dosage of a different medicament and means for injecting said dosage into the tissue of the individual effecting the selfadministration of the injector, each of which medicaments (a) when so injected is generally effective to reduce the incidence of adverse cardiac conditions, such as ectopic beats, when the existing heart beat condition is within a different predetermined portion of the total range of heart beat conditions which may exist during an attack, and (b) may be inadvisable or unwise to inject when such heart beat conditions are outside the predetermined portion of the total range in which the medicament is effective as aforesaid, and

a diagnosing device having sensing means operable to be simply and conveniently disposed in operative relation to an individual for sensing a phenomena indicative of the existing heart beat conditions of the individual and battery operated signal producing means operable when said sensing means is disposed in said operative relation to produce signals indicative of the sensed heart beat conditions of the individual, including a signal corresponding with each successive heartbeat of the individual capable of being transmitted by telephone,

said injectors and said diagnosing device having means for enabling a coronary prone individual to retain said injectors and device in a position of access substantially at all times so that during a time within the early minutes or hours after the onset of heart attack symptoms experienced by the individual access to said device can be obtained enabling the individual to dispose said sensing means in said operative relation and to thereby operate said signal producing means to produce signals utilizable to provide an indication that an identifiable injector when self-administered is effective by virtue of the medicament injected therefrom to reduce the incidence of adverse cardiac conditions, such as ectopic beats, in the individual prior to the arrival of the individual at a hospital.

9. Apparatus as defined in claim 8 wherein said plurality of injectors includes first and second injectors containing first and second medicaments, respectively:

said retention enabling means of said first and second injectors comprising first and second container means for enabling a coronary prone individual to easily and conveniently carry said first and second injectors and for presenting a visual appearance having a characteristic which is distinctive as between said first and second injectors;

said retention enabling means of said diagnosing de vice comprising housing means for enabling a coronary prone individual to easily and conveniently carry said device; first and second medicament identifying means carried by said housing means for presenting a visual appearance having a characteristic which is (1) distinctive as between said first and second medicament identifying means and (2) corresponds respectively to the visual appearance characteristic which is distinctive as between said first and second container means; and

means carried by said housing means and operatively connected with said sensing means (1) for clearly visually designating said first medicament identifying means when the heart beat condition sensed by said sensing means is within said predetermined portion of the total range of heart beat conditions within which said first medicament is effective as aforesaid and (2) for clearly visually designating said second medicament identifying means when the heart beat condition sensed by said sensing means is within said predetermined portion of the ,total range of heart beat conditions within which said second medicament is effective as aforesaid so that a coronary prone individual using said device under the disconcerting circumstances during the aforesaid time is provided with a clearly visually designated distinctive visual appearance characteristic which corresponds to the visual appearance characteristic of the container means containing the medicament which, when the associated injector is self-administered, is effective for the existing heart beat conditions of the individual.

10. Apparatus as defined in claim 9 wherein said visual appearance characteristic is color and said first and second medicament identifying means includes first and second lamps connected to be selectively energized as aforesaid by said designating means.

11. Apparatus as defined in claim9 wherein said injectors are automatic, said first medicament is atropine, and said second medicament is lidocaine.

12. Apparatus as defined in claim 9 wherein said sensing means includes means disposable in operative relation to a finger of a coronary prone. individual for sensing the pulsing of the blood in said finger.

13.'Apparatus for effecting pre-hospital phase selfadministered treatment of a coronary prone individual at a time during the early minutes or hours after the onset of heart attack symptoms and for enabling qualified personnel to participate by telephone in such treatment, comprising the combination of:

at least one injector suitable for self-administration under the disconcerting circumstances present during the aforesaid time containing a liquid dosage of a medicament and means for injecting said dosage into the tissue of the individual effecting the selfadministration of the injector, which medicament (a) when so injected is generally effective to reduce the incidence of adverse cardiac conditions, such as ectopic beats, when the existing heart beat condition is within a predetermined portion of the total range of heart beat conditions which may exist during an attack, and (b) may be inadvisable or unwise to inject when such heart beat conditions are outside the predetermined portion of the total range in which the medicament is effective as aforesaid, and

a diagnosing device having sensing means operable to be simply and conveniently disposed in operative relation to an individual for sensing a phenomena indicative of the existing heart beat conditions of the individual and battery operated signal producing means operable when said sensing means is disposed in said operative relation to produce signals indicative of the sensed heart beat conditions of the individual, including a signal corresponding with each successive heart beat of the individual capable of beingtransmitted by telephone,

said injector and said diagnosing device having means for enabling a coronary prone individual to retain said injector and device in a position of access substantially at all times so that during a time within the early minutes or hours after the onset of heart attack symptoms experienced by the individ ual access to said device can be obtained enabling the individual to dispose said sensing means in said operative relation and to thereby operate said signal producing means to produce signals utilizable to provide an indication that the injector when selfadministered is effective by virtue of the medicament injected therefrom to reduce the incidence of adverse cardiac conditions, such as ectopic beats, in the individual prior to the arrival of the individual at a hospital. 

1. obtaining access to the aforesaid accessible device and injectors by said individual;
 1. A method for effecting pre-hospital phase self-administered treatment of a coronary prone individual at a time during the early minute or hours after the onset of heart attack symptoms and for enabling qualified personnel to participate by telephone in such treatment, which individual has previously been provided with ready access to (1) a plurality of separate injectors suitable for self-administration under the disconcerting circumstances present during the aforesaid time, each containing a liquid dosage of a different medicament injectable into the tissue of the individual effecting the self-administration of the injector, each of which medicaments (a) when so injected is generally effective to reduce the incidence of adverse cardiac conditions, such as ectopic beats, when the existing heart beat condition is within a different predetermined portion of the total range of heart beat conditions which may exist during an attack, and (b) may be inadvisable or unwise to inject when such heart beat conditions are outside the predetermined portion of the total range in which the medicament is effective as aforesaid, and (2) a diagnosing device having sensing means operable to be simply and conveniently disposed in operative relation to an individual for sensing a phenomena indicative of the individual''s heart beat conditions and battery operated signal producing means operable when said sensing means is disposed in said operative relation to produce signals indicative of the sensed heart beat conditions of the individual, including a signal corresponding with each successive heart beat of the individual capable of being transmitted by telephone, said method comprising the steps of:
 1. obtaining access to the aforesaid accessible device and injector by said individual;
 2. manually establishing by said individual an operative relation between said individual and the sensing means;
 2. A method as defined in claim 1 wherein the produced signals include at least one of a plurality of different visual signals each of which is produced by the signal means when a different predetermined portion of the total range of heart beat conditions corresponding respectively to the aforesaid different rate portions associated with each medicament is sensed by said sensing means.
 2. manually establishing by said individual an operative relation between said individual and the sensing means of the device to which access has been obtained as aforesaid;
 3. sensing through the operation of the sensing means while in said operative relation a phenomena indicative of the existing heart beat conditions of the individual;
 3. A method as defined in claim 2 wherein the visual signals produced are colored lights, corresponding injectors having color indicia corresponding in color respectively to said colored lights, and wherein said individual experiencing heart attack symptoms utilizes the colored light produced by said signal means as a basis for determining the indicated effective medicament and identifies the injector containing the indicated effective medicament by identifying the injector having color indicia corresponding to the color of the produced colored light.
 3. sensing through the operation of the sensing means while in said operative relation a phenomena indicative of the existing heart beat conditions of the individual;
 4. producing through the operation of said battery operated signal producing means signals indicative of the existing heart beat conditions of said individual including a signal corresponding with each successive heart beat of said individual capable of being transmitted by telephone;
 4. A method as defined in claim 1 wherein the medicaments contained within the injectors include atropine and lidocaine.
 4. producing through the operation of said battery operated signal producing means signals indicative of the sensed heart beat conditions of said individual including a signal corresponding with each successive heart beat of said individual capable of being transmitted by telephone;
 5. utilizing at least some of the signals produced as aforesaid as a basis for determining an indicated injector containing the medicament which is effective as aforesaid;
 5. A method as defined in claim 1 wherein the injection of the medicament is accomplished automatically by The injector during said self-administering step.
 5. utilizing at least some of the signals produced as aforesaid as a basis for determining that the injector obtained by said individual contains medicament which is effective as aforesaid;
 6. visually identifying by said individual the injector containing the effective medicament, and
 6. visually identifying by said individual the indicated injector containing the effective medicament as aforesaid, and
 6. A method as defined in claim 5 wherein the medicaments contained within the injectors include atropine and lidocaine, the portion of the total range of the heart beat conditions wherein atropine is effective as aforesaid being a heart beat rate below 60 to 65 beats per minute, above which atropine may be inadvisable to inject as aforesaid and wherein each signal corresponding to each successive heart beat is a distinct audible signal, such as a beep.
 7. self-administering by said individual the identified injector containing the effective medicament and injecting said effective medicament into the tissue of said individual so that said injected medicament will reduce the incidence of adverse cardiac conditions, such as ectopic beats, in said individual prior to the arrival of said individual at a hospital.
 7. self-administering by said individual the identified injector containing the effective medicament and injecting said effective medicament into the tissue of said individual so that said injected medicament will reduce the the incidence of adverse cardiac conditions, such as ectopic beats, in said individual prior to the arrival of said individual at a hospital.
 7. A method for effecting pre-hospital phase self-administered treatment of a coronary prone individual at a time during the early minutes or hours after the onset of heart attack symptoms and for enabling qualified personnel to participate by telephone in such treatment, which individual has been previously provided with ready access to (1) at least one injector suitable for self-administration under the disconcerting circumstances present during the aforesaid time containing a liquid dosage of a medicament injectable into the tissue of the individual effecting the self-administration of the injector, which medicament (a) when so injected is generally effective to reduce the incidence of adverse cardiac conditions, such as ectopic beats, when the existing heart beat condition is within a predetermined portion of the total range of heart beat conditions which may exist during an attack, and (b) may be inadvisable or unwise to inject when such heart beat conditions are outside the predetermined portion of the total range in which the medicament is effective as aforesaid, and (2) a diagnosing device having sensing means operable to be simply and conveniently disposed in operative relation to an individual for sensing a phenomena indicative of the individual''s heart beat condition and battery operated signal producing means operable, when said sensing means is disposed in said operative relation to produce signals indicative of the sensed heart beat conditions of the individual, including a signal corresponding with each successive heart beat of the individual capable of being transmitted by telephone, said method comprising the steps of:
 7. A method for effecting pre-hospital phase self-administered treatment of a coronary prone individual at a time during the early minutes or hours after the onset of heart attack symptoms and for enabling qualified personnel to participate by telephone in such treatment, which individual has been previously provided with ready access to (1) at least one injector suitable for selfadministration under the disconcerting circumstances present during the aforesaid time containing a liquid dosage of a medicament injectable into the tissue of the individual effecting the self-administration of the injector, which medicament (a) when so injected is generally effective to reduce the incidence of adverse cardiac conditions, such as ectopic beats, when the existing heart beat condition is within a predetermined portion of the total range of heart beat conditions which may exist during an attack, and (b) may be inadvisable or unwise to inject when such heart beat conditions are outside the predetermined portion of the total range in which the medicament is effective as aforesaid, and (2) a diagnosing device having sensing means operable to be simply and conveniently disposed in operative relation to an individual for sensing a phenomena indicative of the individual''s heart beat condition and battery operated signal producing means operable, when said sensing means is disposed in said operative relation to produce signals indicative of the sensed heart beat conditions of the individual, including a signal corresponding with each successive heart beat of the individual capable of being transmitted by telephone, said method comprising the steps of:
 1. obtaining access to the aforesaid accessible device and injector by said individual;
 2. manually establishing by said individual an operative relation between said individual and the sensing means;
 3. sensing through the operation of the sensing means while in said operative relation a phenomena indicative of the existing heart beat conditions of the individual;
 4. producing through the operation of said battery operated signal producing means signals indicative of the existing heart beat conditions of said individual including a signal corresponding with each successive heart beat of said individual capable of being transmitted by telephone;
 5. utilizing at least some of the signals produced as aforesaid as a basis for determining that the injector obtained by said individual contains medicament which is effective as aforesaid;
 6. visually identifying by said individual the injector containing the effective medicament, and
 7. self-administering by said individual the identified injector containing the effective medicament and injecting said effective medicament into the tissue of said individual so that said injected medicament will reduce the the incidence of adverse cardiac conditions, such as ectopic beats, in said individual prior to the arrival of said individual at a hospital.
 8. Apparatus for effecting pre-hospital phase self-administered treatment of a coronary prone individual at a time during the early minutes or hours after the onset of heart attack symptoms and for enabling qualified personnel to participate by telephone in such treatment comprising the combination of: a plurality of separate injectors suitable for self-administration under the disconcerting circumstances present during the aforesaid time, each containing a liquid dosage of a different medicament and means for injecting said dosage into the tissue of the individual effecting the self-administration of the injector, each of which medicaments (a) when so injected is generally effective to reduce the incidence of adverse cardiac conditions, such as ectopic beats, when the existing heart beat condition is within a different predetermined portion of the total range of heart beat conditions which may exist during an attack, and (b) may be inadvisable or unwise to inject when such heart beat conditions are outside the predetermined portion of the total range in which the medicament is effective as aforesaid, and a diagnosing device having sensing means operable to be simply and conveniently disposed in operative relation to an individual for sensing a phenomena indicative of the existing heart beat conditions of the individual and battery operated signal producing means operable when said sensing means is disposed in said operative relation to produce signals indicative of the sensed heart beat conditions of the individual, including a signal corresponding with each successive heart beat of the individual capable of being transmitted by telephone, said injectors and said diagnosing device having means for enabling a coronary prone individual to retain said injector and device in a position of access substantially at all times so that during a time within the early minutes or hours after the onset of heart attack symptoms experienced by the individual access to said device can be obtained enabling the individual to dispose said sensing means in said operative relation and to thereby operate said signal producing means to produce signals utilizable to provide an indication that an identifiable injector when self-administered is effective by virtue of the medicament injected therefrom to reduce the incidence of adverse cardiac conditions, such as ectopic beats, in the individual prior to the arrival of the individual at a hospital.
 9. Apparatus as defined in claim 8 wherein said plurality of injectors includes first and second injectors containing first and second medicaments, respectively: said retention enabling means of said first and second injectors comprising first and second container means for enabling a coronary prone individual to easily and conveniently carry said first and second injectors and for presenting a visual appearance having a characteristic which is distinctive as between said first and second injectors; said retention enabling means of said diagnosing device comprising housing means for enabling a coronary prone individual to easily and conveniently carry said device; first and second medicament identifying means carried by said housing means for presenting a visual appearance having a characteristic which is (1) distinctive as between said first and second medicament identifying means and (2) corresponds respectively to the visual appearance characteristic which is distinctive as between said first and second container means; and means carried by said housing means and operatively connected with said sensing means (1) for clearly visually designating said first medicament identifying means when the heart beat condition sensed by said sensing means is within said predetermined portion of the total range of heart beat conditions within which said first medicament is effective as aforesaid and (2) for clearly visually designating said second medicament identifying means when the heart beat condition sensed by said sensing means is within said predetermined portion of the total range of heart beat conditions within which said second medicament is effective as aforesaid so that a coronary prone individual using said device under the disconcerting circumstances during the aforesaid time is provided with a clearly visually designated distinctive visual appearance characteristic which corresponds to the visual appearance characteristic of the container means containiNg the medicament which, when the associated injector is self-administered, is effective for the existing heart beat conditions of the individual.
 10. Apparatus as defined in claim 9 wherein said visual appearance characteristic is color and said first and second medicament identifying means includes first and second lamps connected to be selectively energized as aforesaid by said designating means.
 11. Apparatus as defined in claim 9 wherein said injectors are automatic, said first medicament is atropine, and said second medicament is lidocaine.
 12. Apparatus as defined in claim 9 wherein said sensing means includes means disposable in operative relation to a finger of a coronary prone individual for sensing the pulsing of the blood in said finger. 